Spine Chiropractic:スパインカイロプラクティック
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2025年1月
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11:00
11:40
12:20
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14:20
15:00
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16:20
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20:20
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アンケート
Have you received chiropractic or osteopathic treatment before?
What specific symptoms are you experiencing? You can select multiple answers(必須)
When did the symptoms start?
What kind of movements cause the pain?
When does the pain occur?(必須)
Open-ended Response: If there is anything you would like to inform me of or ask in advance (if not, “no” is fine), please fill it out and I will address it during your visit.
If you were referred, please write the name of the person who referred you below.